Payment slip-ups still plague state health-insurance exchange

Customers of the state health-insurance exchange who have “stuck accounts” remain in a limbo that, for them, may seem endless.

The problem is acute enough that the Legislature’s Joint Select Committee on Health Care Oversight spent much of its hearing last week questioning exchange officials over what’s being done and who’s responsible.

For months now, some customers who have purchased insurance policies through the Washington Healthplanfinder have had problems with their accounts. In particular, many have made premium payments through the exchange (as the system was set up), only to find out later the insurer had not received the payments, keeping those customers from being covered.

One such case is Evelyn Wilhelmson, 61, of Spokane, who successfully signed up in December and set up her account so that payments would be automatically made from her bank.

“I had some trips that I wanted to do and I didn’t want to have to remember to get payments out,” she said.

But in June, when she visited the exchange site, she noticed there was a termination notice. “They didn’t tell me that there was a notice,” Wilhelmson said. “I discovered it on my own.”

Despite many calls to the Washington Health Benefit Exchange, which administers Healthplanfinder, she has not been able to get proof of insurance coverage. As a result, she said she had to cancel a long-planned trip to Norway in July, since that country requires visitors to have proof of health insurance.

In Thursday’s legislative hearing, Rep. Eileen Cody, D-West Seattle, asked Pam MacEwan, chief of staff of the exchange, what consumers are to do when they’ve paid their premiums but are told by insurers or providers they don’t have coverage.

“Let’s say you’re going to the doctor and needing treatment. Who is going to be liable for the bill?” Cody asked.

“It’s the exchange’s responsibility,” MacEwan replied.

Cody said that even if the exchange eventually makes good on consumers’ insurance claims, the uncertainty “is adding a level of stress that shouldn’t be there for people.”

Elusive bugs

While several senators and representatives pressed the exchange and insurance carriers for estimates of people affected by the glitches, accurate numbers are hard to come by.

“It’s like the phone book,” said Michael Marchand, communications director of the exchange. “It’s out of date almost as soon as it’s printed.”

According to Marchand, the exchange’s best estimate is that as of July 1 there were approximately 6,000 accounts that had some problem with payments being accurately recorded and forwarded to insurance companies.

In some cases, exchange staff members are able to resolve account problems by making manual changes. “That’s not any way to run a railroad over the long term,” MacEwan told legislators Thursday, “but it is addressing the most urgent needs right now.”

In many cases, however, manual changes don’t stick. “That is just putting a Band-Aid on it to get it over to the carrier, and in the next month when it runs again it generates errors,” said Marchand.

The only real solution, he said, is for programmers to track down the bugs in the code and fix them. “We’ve been working closely with Deloitte, our IT integrator, to identify and solve these as quickly as possible,” he said.

Part of the problem, notes exchange board member Don Conant, is that the system couldn’t be tested using real data before going live. “We’ve had to do beta testing with real people and real money, real insurance and real sicknesses, where every error has a tremendous downside,” said Conant.

Still, said Conant, “Those are excuses. They were explanations two months ago, but they are excuses now. We recognize that.”

According to some exchange board members, the issue underlying the technical problem was the exchange’s decision to collect premiums from individual consumers and to manage payments to insurers. “That’s where the problem is,” said exchange board member Bill Hinkle. There has been increased discussion about abandoning the practice, he said, though adding, that “I’m not sure that there is a consensus on the board yet.”

At least one insurance company would also like to see the exchange abandon managing payments.

“The ACA does not require exchanges … to collect premium payments from individual members,” said Melanie Coon, spokeswoman for Premera Blue Cross. She said Premera advised against it when the exchange was considering it several years ago.

Others, however, argue that there are important benefits to the exchange handling payments. “One of the reasons we did it was so that we can more readily show the Legislature and others who want to monitor this, who had paid and who hadn’t,” said Conant. “We are one of only two or three states to do that.”

Conant said that once the system is fixed, it’s also in the consumers’ interest to have the exchange handle payments. He acknowledged the system may have to be changed if it isn’t fixed by the next open-enrollment period, which begins in November.

The exchange’s MacEwan said there are a lot of hidden difficulties in abandoning the payments system. “We have built our system to handle the payments, so changing it back to the carriers is not that simple,” she told the joint committee. “We would have to change our system to do that and it would be lengthy and expensive to do that.”

No resolution

Thursday’s committee hearing ended without any clear promises regarding resolution of the problems.

“I just want to know when it’s going to get fixed,” said Sen. Karen Keiser, D-Kent. “Do you have a timeline when you tell us this is going to be resolved?”

“The outer limit of this to me is the beginning of open enrollment,” replied MacEwan. “But we want to be fixed well before that. I would say by the end of July or early August.”

In the meantime, customers like Ryan O’Keven, 31, of Seattle, will apparently have to keep pushing the exchange to manually fix his account.

“I was told the normal monthly billing will probably not work for me still, so I’ll have to contact the exchange again in a couple months to make additional payments,” said O’Keven.

O’Keven said that since January he has made 88 calls to the exchange for a total 1,824 minutes. His problem still isn’t resolved.

Patrick Marshall is a freelance technology writer in Seattle. This story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation.